Feasibility of using teleradiology to improve tuberculosis screening and case management in a district hospital in Malawi.

Malawi has one of the world's highest rates of human immunodeficiency virus (HIV) infection (10.6%), and southern Malawi, where Thyolo district is located, bears the highest burden in the country (14.5%). Tuberculosis, common among HIV-infected people, requires radiologic diagnosis, yet Malawi has no radiologists in public service. This hinders rapid and accurate diagnosis and increases morbidity and mortality

The Impact of Bisphenol A and Triclosan on Immune Parameters in the U.S. Population, NHANES 2003–2006

Background: Exposure to environmental toxicants is associated with numerous disease outcomes, many of which involve underlying immune and inflammatory dysfunction. Objectives: To address the gap between environmental exposures and immune dysfunction, we investigated the association of two endocrine-disrupting compounds (EDCs) with markers of immune function. Methods: Using data from the 2003–2006 National Health and Nutrition Examination Survey, we compared urinary bisphenol A (BPA) and triclosan levels with serum cytomegalovirus (CMV) antibody levels and diagnosis of allergies or hay fever in U.S. adults and children ≥ 6 years of age. We used multivariate ordinary least squares linear regression models to examine the association of BPA and triclosan with CMV antibody titers, and multivariate logistic regression models to investigate the association of these chemicals with allergy or hay fever diagnosis. Statistical models were stratified by age (\u3c 18 years and ≥ 18 years). Results: In analyses adjusted for age, sex, race, body mass index, creatinine levels, family income, and educational attainment, in the ≥ 18-year age group, higher urinary BPA levels were associated with higher CMV antibody titers (p \u3c 0.001). In the \u3c 18-year age group, lower levels of BPA were associated with higher CMV antibody titers (p \u3c 0.05). However, triclosan, but not BPA, showed a positive association with allergy or hay fever diagnosis. In the \u3c 18-year age group, higher levels of triclosan were associated with greater odds of having been diagnosed with allergies or hay fever (p \u3c 0.01). Conclusions: EDCs such as BPA and triclosan may negatively affect human immune function as measured by CMV antibody levels and allergy or hay fever diagnosis, respectively, with differential consequences based on age. Additional studies should be done to investigate these findings

General anaesthetic and airway management practice for obstetric surgery in England: a prospective, multi-centre observational study

There are no current descriptions of general anaesthesia characteristics for obstetric surgery, despite recent changes to patient baseline characteristics and airway management guidelines. This analysis of data from the direct reporting of awareness in maternity patients' (DREAMY) study of accidental awareness during obstetric anaesthesia aimed to describe practice for obstetric general anaesthesia in England and compare with earlier surveys and best-practice recommendations. Consenting patients who received general anaesthesia for obstetric surgery in 72 hospitals from May 2017 to August 2018 were included. Baseline characteristics, airway management, anaesthetic techniques and major complications were collected. Descriptive analysis, binary logistic regression modelling and comparisons with earlier data were conducted. Data were collected from 3117 procedures, including 2554 (81.9%) caesarean deliveries. Thiopental was the induction drug in 1649 (52.9%) patients, compared with propofol in 1419 (45.5%). Suxamethonium was the neuromuscular blocking drug for tracheal intubation in 2631 (86.1%), compared with rocuronium in 367 (11.8%). Difficult tracheal intubation was reported in 1 in 19 (95%CI 1 in 16-22) and failed intubation in 1 in 312 (95%CI 1 in 169-667). Obese patients were over-represented compared with national baselines and associated with difficult, but not failed intubation. There was more evidence of change in practice for induction drugs (increased use of propofol) than neuromuscular blocking drugs (suxamethonium remains the most popular). There was evidence of improvement in practice, with increased monitoring and reversal of neuromuscular blockade (although this remains suboptimal). Despite a high risk of difficult intubation in this population, videolaryngoscopy was rarely used (1.9%)

The Characteristics of Disclosure among Children Who May have been Sexually Abused

Seventy-six children (5 to 10 years old), who were referred because of concerns about sexual abuse, were interviewed as part of a larger study testing the efficacy of a computerassisted interview in sexual abuse evaluations. Data from initial interviews were coded according to the presence of disclosure and the details revealed about sexual abuse. The presence and amount of corroboration were coded through case review. Although 56 children were coded as having disclosed prior to evaluation, only 44 subjects disclosed during the initial interview. Only 1 child disclosed spontaneously. An additional 8 children (11%) disclosed possible sexual abuse in a second or later interview. Although girls disclosed at a higher rate than boys, children did not differ in the amount or types of information they provided about alleged sexual abuse. Findings are discussed in terms of the conceptualization of disclosure as a process. Implications for interviewing strategies are addressed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66798/2/10.1177_1077559599004003003.pd